High-dose cytosine arabinoside and L-asparaginase in refractory acute lymphoblastic leukemia: the Children's Cancer Group experience.
OBJECTIVE
Therapy of children with relapsed acute lymphoblastic leukemia (ALL) not achieving a second remission (CR2) after an initial reinduction attempt is problematic.


METHODS
52 children with ALL in first relapse received high-dose cytosine arabinoside and L-asparaginase (HDAraC/L-Asp) after failed attempts to achieve CR2. AraC was given at a dose of 3 gm/m2 q12 h x 4 on days 0-1 and 7-8. L-asparaginase was given IM 6,000 IU/m2 3 hours after completion of each 2-day cycle of AraC.


RESULTS
Of the 42 surviving to day 28, 22 (42% of all patients) achieved CR2. Ten died before day 28 (19%); four from leukemia and six from infections or toxicity (12% regimen-related mortality), There were 17 bacterial infections (three fatal), 17 invasive fungal infections (12 fatal), one fatal adenoviral infection, and one-non-fatal Pneumocystis pneumonia. One patient was surviving when lost to follow-up at four months and one patient survives over 5 years after transplant. Sixteen of the 22 patients who entered CR2 subsequently relapsed, five died of non-leukemic causes, and one was lost to follow-up. The median duration of second remission was 3 months (range 0.7 to 19 months).


CONCLUSIONS
HDAraC/L-Asp rescue reinduction for relapsed childhood ALL achieves CR2 in approximately 40% of patients who fail reinduction, but remissions are short for most patients and maintenance of CR2 remains unsatisfactory.
Harris
R E
RE
Stem Cell Transplanting Program, Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Sather
H N
HN
Feig
S A
SA
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007239:Infections / Q000139:chemically induced; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome
D003561:Cytarabine; D001215:Asparaginase